Renewal or Change of Contact Details form

This page will enable you to either RENEW an existing membership or advise of CHANGE of CONTACT DETAILS.

Membership renewal fees can be paid either by sending a cheque to the QAM postal address or alternatively by Electronic Funds Transfer deposit to QAM’s bank account which are both displayed by scrolling down to the bottom of this page. The information is also embedded in the form. Please remember to note your name with EFT payment. Payment to the Front Counter entry staff at the museum itself is also an option. Payment is required as part of the renewal process.

Full Membership

$

40.00

Senior / Concession / Student / Junior

$

25.00

Each Additional Family Member ( at same address )

$

12.00

Please indicate your Type of Request: ( click one or the other button )Renewal for a further calendar yearChange of contact details

If this a membership RENEWAL and if your membership details have NOT changed, please click in the "No Change" box and leave the unchanged sections of this form blank. This will assist our Membership Secretary.

NO CHANGE ( please click in box if applicable ): I am renewing my existing membership and my membership details have not changed since my last renewal.

First Name: (required)

Last Name: (required)

Email:

Membership class renewal: ( choose one )

Additional Family Members ( Optional, each- $12.00 ) - please list any additional family members to be renewed. Additional family members must reside at same address:

Show total payment due for all membership renewals requested in box below:

Please indicate your method of payment: ( choose one )

Agree- click in box at right: ( required ) All applicants agree to abide by the conditions of the QAM Constitution